Salutogenic Education? Movement and Whole Child Health in a Waldorf (Steiner) School

Children in the Anthroposophical Education System Have Lower Rates of Obesity, and Higher Rates of Health Promoting Behaviors

BACKGROUND

The anthroposophical philosophy is a holistic educational and lifestyle approach. Limited information exists on the health-promoting behavioral norms and obesity rates among children living anthroposophical vs. conventional lifestyles.

AIMS

This study aims to compare the prevalence of childhood obesity, and parents' perceptions of their children's food environment, between anthroposophical and conventional education systems.

METHODS

We performed a cross-sectional analysis of the National Anthropometric Measurement Survey for first grade students in Israel, comparing anthroposophical schools with matched conventional schools. Additionally, an online survey was distributed among parents of children in both school systems, assessing children's eating norms and dietary intake.

RESULTS

Overweight and obesity rates were higher among students in conventional schools (n = 205,500) compared to anthroposophical schools (n = 2247) (11.2% vs. 9.6%, and 7.8% vs. 4.8%, respectively; Pv < 0.001). Anthroposophical schools were perceived by more parents to have health-promoting curricula, health promoting teacher behavior, and health promoting social dietary norms, while their children's dietary intake was perceived as healthier both in school and in the after-school, social, and familial environment (Pv < 0.001).

CONCLUSIONS

Children in anthroposophical education exhibited lower overweight and obesity rates, and engaged in more health-promoting behaviors. Further research is needed to explore the relationship between the anthroposophical lifestyle and childhood obesity, and to identify effective anthroposophical strategies for health promotion among children.

Determinants of COVID-19 vaccine hesitancy and uptake in sub-Saharan Africa: a scoping review

OBJECTIVE

To identify, describe and map the research tools used to measure COVID-19 vaccine hesitancy, refusal, acceptance and access in sub-Saharan Africa (SSA).

DESIGN

Scoping review.

METHODS

In March 2022, we searched PubMed, Scopus, Web of Science, Cochrane, Academic Search Premier, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Health Source Nursing, Africa Wide and APA PsychInfo for peer-reviewed literature in English related to COVID-19 vaccine hesitancy, refusal, acceptance and access in SSA. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to guide evidence gathering and as a template to present the evidence retrieval process.

RESULTS

In the studies selected for review (n=72), several measurement tools were used to measure COVID-19 vaccine hesitancy, acceptance and refusal. These measurements were willingness and intent to vaccinate from the perspectives of the general population, special population groups such as mothers, students and staff in academic institutions and healthcare workers and uptake as a proxy for measuring assumed COVID-19 vaccine acceptance. Measurements of access to COVID-19 vaccination were cost and affordability, convenience, distance and time to travel or time waiting for a vaccine and (dis)comfort. Although all studies measured COVID-19 vaccine hesitancy, acceptance and refusal, relatively few studies (n=16, 22.2%) included explicit measurements of access to COVID-19 vaccination.

CONCLUSIONS

Based on the gaps identified in the scoping review, we propose that future research on determinants of COVID-19 vaccination in SSA should further prioritise the inclusion of access-related variables. We recommend the development and use of standardised research tools that can operationalise, measure and disentangle the complex determinants of vaccine uptake in future studies throughout SSA and other low- and middle-income country (LMIC) settings.

'Get your own house in order': Qualitative dialogue groups with nonvaccinating parents on how measles outbreaks in their community should be managed

Objective

Communities with high levels of vaccine rejection present unique challenges to vaccine‐preventable disease outbreak management. We sought perspectives of nonvaccinating parents to inform public health responses in such communities.

Methods

Nineteen purposively sampled nonvaccinating Australian parents participated in one of seven online dialogue groups. We asked what they thought parents, school principals and public health professionals should do in a hypothetical school measles outbreak and used a framework approach to data analysis.

Results

Parents' views were grounded in strong beliefs in parental responsibility and the belief that vaccines are not effective, thus unvaccinated children do not therefore pose a threat. They then reasoned that the forced exclusion of unvaccinated children from school in a measles outbreak was disproportionate to the risk they pose, and their child's right to education should not be overridden. Nonvaccinating parents judged that all parents should keep sick children at home regardless of disease or vaccination status; that school principals should communicate directly with parents and avoid using social media; that public health professionals should provide information to parents so they can decide for themselves about excluding their children from school; that public health responses should avoid accidental identification of unvaccinated children and that mainstream media should be avoided as a communication tool.

Conclusion

Nonvaccinating parents do not always agree with current Australian approaches to measles outbreak management. Their perspectives can inform approaches to outbreak responses in communities with high levels of vaccine rejection.

Patient or Public Contribution

We sought input from individuals who did and did not vaccinate on study design in its early phases. Individual conversations were used deliberately as we felt the group advisory situation may have felt less safe for nonvaccinating parents, given the divisive and often hostile nature of the topic.

Preschoolers’ Attitudes, School Motivation, and Executive Functions in the Context of Various Types of Kindergarten

European policy has seen a number of changes and innovations in the field of early childhood preschool education over the last decade, which have been reflected in various forms in the policies of individual EU countries. Within the Czech preschool policy, certain innovations and approaches have been implemented in the field of early children education, such as the introduction of compulsory preschool education before entering primary school from 2017, emphasis on inclusive education, equal conditions in education and enabling state-supported diversity in the education concepts of kindergartens. The aim of our study was to assess the influence of various preschool education systems in the Czech Republic in the context of psychological variables reflecting selected children’s outcomes which may contribute to future school achievement. The monitored variables were the attitudes, motivations and executive functions of children in the last year of preschool education. A comparison was made between the traditional preschool education program and the so-called alternative types of preschool education, such as Montessori, Waldorf and religious schools. The total sample was divided into four subgroups, namely a group of children attending traditional kindergartens (731, 84.9%), religious (65, 7.5%), Montessori (35, 4.1%), and Waldorf (30, 3.5%) kindergartens. To determine empirical data, the following research methods were used: Attitude Questionnaire, School Performance Motivation Scale, and Behavior Rating Inventory of Executive Function (BRIEF). The results of our survey show the fact that the type of kindergarten attended has a significant effect on the child’s level of school performance motivation, attitudes toward school as well as executive functions. Significant differences were found between the different types of kindergartens attended in the monitored variables.

Trust, affect, and choice in parents' vaccination decision-making and health-care provider selection in Switzerland

This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents' vaccination decision-making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon-parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%-50% of the Swiss population and is integrated into the Swiss health-care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in-depth semi-structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear-cut, direct relationship between (non)vaccination and parents' use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents' provider selection and vaccination decision-making process, although only four families in the sample described switching solely because of vaccination-related issues. Findings add to vaccine decision-making literature by describing and analysing the underdiscussed provider-switching phenomenon and by demonstrating the importance of parents' experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: A qualitative study in Australia

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level.

A General Pediatrics and Integrative Medicine Approach to Pervasive Refusal Syndrome: A Case Report

INTRODUCTION

Pervasive refusal syndrome (PRS) describes children with social withdrawal who become unable to walk, eat, or care for themselves. This case report examines whether an integrative medicine approach is useful for treating PRS.

CASE PRESENTATION

A seven-year-old girl with symptoms most consistent with PRS and depression was admitted to a pediatric ward in Germany that integrates conventional pediatric and psychosomatic care with anthroposophic medicine. She was integrated into the structured activities of the ward and received massages, movement therapy, and color light therapy. Her parents were fully integrated into her care. After four weeks, she talked again, showed increased appetite, and supported herself when moved passively. She made a full recovery within four weeks after hospital discharge.

DISCUSSION

Integration of parents and an integrative medicine approach providing a variety of comforting sensory experiences was helpful for this patient with PRS.